The news for epinephrine in cardiac arrest keeps getting worse – it restarts the heart, but at what cost, and with what outcomes?

This is a study, published in JAMA, of 417,188 out-of-hospital cardiac arrest patients in Japan – only 15,030 of which received epinephrine during prehospital transport – a far cry from the U.S., where the toolbox has typically already been emptied prior to the ED. Nearly every baseline characteristic favored the epinephrine group – more witnessed arrests, more received bystander CPR, a physician was more frequently in the ambulance, more patients in ventricular fibrillation/PEA. However, more of these patients also received an advanced airway, which has also been associated with worse outcomes.